Survey Of Facilities Research Articles

Identifi cation of the Postharvest Pink Mold Rot Fungus (Trichothecium roseum) on Grapes in China

Grape is an important crop due to its consumption as fresh fruit as well as the secondary products developed from the berries such as wines, jams, juice, jellies, and vinegar. Postharvest losses in grapes can adversely affect their market value and the quality of the secondary products developed from grapes. These losses can be due to pathogenic infections and other damage due to improper handling and storage practices. During a brief survey of the cold storage facilities of the Beijing Academy of Forestry and Pomology Sciences, grape berries showing postharvest rot symptoms were collected. Further onsite observations suggested that the disease was postharvest pink mold rot caused by Trichothecium roseum. Trichothecium roseum is an asexually reproducing soil-borne fungus with an unknown sexual morph. This fungus is known to cause postharvest diseases in many fruits and vegetables around the world. Our objective in this study was to report the fi rst occurrence of pink rot on grapes caused by T. roseum with molecular phylogeny, morphological studies, and pathogenicity tests. Also, this is the fi rst report of T. roseum from grapes in China.

A small area model to assess temporal trends and sub-national disparities in healthcare quality

Monitoring subnational healthcare quality is important for identifying and addressing geographic inequities. Yet, health facility surveys are rarely powered to support the generation of estimates at more local levels. With this study, we propose an analytical approach for estimating both temporal and subnational patterns of healthcare quality indicators from health facility survey data. This method uses random effects to account for differences between survey instruments; space-time processes to leverage correlations in space and time; and covariates to incorporate auxiliary information. We applied this method for three countries in which at least four health facility surveys had been conducted since 1999 – Kenya, Senegal, and Tanzania – and estimated measures of sick-child care quality per WHO Service Availability and Readiness Assessment (SARA) guidelines at programmatic subnational level, between 1999 and 2020. Model performance metrics indicated good out-of-sample predictive validity, illustrating the potential utility of geospatial statistical models for health facility data. This method offers a way to jointly estimate indicators of healthcare quality over space and time, which could then provide insights to decision-makers and health service program managers.

Changes in the readiness of healthcare systems to provide diabetes- and cardiovascular disease-related services: A comparison of indices using data from the 2014 and 2017 Bangladesh Health Facility Surveys

Background: The increasing prevalence of non-communicable diseases (NCDs) in Bangladesh is a significant obstacle for the government's already under-resourced healthcare centers and healthcare management. This study aimed to determine whether healthcare services are prepared to handle cardiovascular disease (CVD) and diabetes in the future. Methods: This cross-sectional study used the Bangladesh Health Facilities Survey (BHFS) 2014 and 2017 data. The BHFS 2014 completed assessment of 317 facilities providing diabetes care and 407 facilities providing CVD care, while the 2017 BHFS included 305 and 368 facilities providing diabetes and CVD care, respectively. Results: A slight increase in facility readiness status was observed in 2017 compared with 2014, though it was not statistically significant. District hospitals (DHs) and Upazila health complexes (UHCs) showed improvement in staff and guidelines, basic equipment, diagnostic capabilities, and essential drugs, as their Readiness Index (RI) value increased in 2017 from 2014. The RI values of non-governmental organizations (NGOs) clinics were 48.65% in 2014, whereas the value was slightly increased to 55.28% in 2017. For private clinics, the RI value diminished in 2017 (56.11%), which was lower than the 2014 survey (60.62%). There was a slightly mixed trend for public and private facilities regarding managing CVDs. In DHs and UHCs, the RI value decreased to 58.5% and 53.06% in 2017 from 64.04% and 53.02% in 2014. NGO clinics were valued at 48.65% in 2014, which dropped to 44.53%. For private clinics, the value showed a decreasing trend as the value in 2017 was 61.58%, lower than the value of 2014 (64.15%). Conclusions: In Bangladesh, public and private healthcare facilities lack readiness for healthcare towards DM and CVD maintenance. It is noteworthy that this improvement has been insignificant over the years in this regard. Healthcare policy reform is urgently required to strengthen NCD healthcare, particularly in public healthcare facilities.

The Prevalence and Influence of Circumstellar Material around Hydrogen-rich Supernova Progenitors

Narrow transient emission lines (flash-ionization features) in early supernova (SN) spectra trace the presence of circumstellar material (CSM) around the massive progenitor stars of core-collapse SNe. The lines disappear within days after the SN explosion, suggesting that this material is spatially confined, and originates from enhanced mass loss shortly (months to a few years) prior to the explosion. We performed a systematic survey of H-rich (Type II) SNe discovered within less than 2 days from the explosion during the first phase of the Zwicky Transient Facility survey (2018–2020), finding 30 events for which a first spectrum was obtained within <2 days from the explosion. The measured fraction of events showing flash-ionization features (>36% at the 95% confidence level) confirms that elevated mass loss in massive stars prior to SN explosion is common. We find that SNe II showing flash-ionization features are not significantly brighter, nor bluer, nor more slowly rising than those without. This implies that CSM interaction does not contribute significantly to their early continuum emission, and that the CSM is likely optically thin. We measured the persistence duration of flash-ionization emission and find that most SNe show flash features for ≈5 days. Rarer events, with persistence timescales >10 days, are brighter and rise longer, suggesting these may be intermediate between regular SNe II and strongly interacting SNe IIn.

Examining Differences in Substance Use Outcomes and Related Correlates among Transfeminine and Transmasculine Adults Using the 2017 New York State Patient Characteristics Survey

Background: Transgender persons in the U.S. experience high levels of violence and discrimination which have been linked to adverse substance use outcomes. Despite transgender women’s higher exposure to such deleterious events compared to transgender men, studies have often aggregated both transgender women and men, obfuscating potentially unique differences between these groups. The current study, guided by the Minority Stress Model, examines differences in substance use outcomes and related correlates among transfeminine and transmasculine adults. Methods: A secondary data analysis was conducted using the 2017 Patient Characteristics Survey of public mental health facilities in the state of New York (N = 1387). Controlling for theoretically relevant factors, logistic regression models were estimated to examine differences between transfeminine and transmasculine adults in alcohol-related disorder (ARD) and drug use-related disorder (DURD) diagnoses, and tobacco use. Correlates of substance use disparities were also examined within gender identity groups. Results: Overall, 35% of participants were documented as using tobacco products whereas 14 and 19% were diagnosed with ARDs and DURDs, respectively. Transfeminine participants were 1.44-times more likely to be diagnosed with ARDs relative to transmasculine adults. Compared to transmasculine and White participants, transfeminine and Black participants were 1.64- and 1.59-times more likely to be diagnosed with DURDs. Conclusions: Recognizing the observed higher hazardous substance use risk among transfeminine and Black participants, findings indicate the potential role of minority stress in health outcomes of stigmatized communities. Our findings emphasize the need for identifying prevention and treatment strategies aimed at mitigating the implications of minority stress.

Developing evidence for building sanitation justice: A multi methods approach to understanding public restroom quantity, quality, accessibility, and user experiences.

Access to basic sanitation is a human right and a critical environmental determinant of health. In this paper, we detail the development of three tools to investigate sanitation justice: (1) our public restroom spatial database, (2) our field assessment tool, and (3) survey of restroom access experiences. We document our process to collect these data in a consistent, health equity-driven framework. Together, these tools comprise a suite of methods for the examination of public restrooms from the macro- to the micro-level, and highlight key opportunities to promote health and well-being among restroom-reliant populations (e.g., people experiencing homelessness) by advancing sanitation justice in the built environment. With an illustrative case study, we demonstrate how methods triangulation, using the tools in concert, can provide a comprehensive assessment of basic sanitation access in a given region-San Diego, CA. We also detail how each tool can also be used separately to assess key sanitation justice and health equity questions that may be of interest to researchers, public health practitioners, policymakers, and advocates, including: (1) where do public restrooms exist (mapping)?; (2) how accessible are public restroom facilities, and what health-supportive features do they have (field assessment)?; and (3) what are the experiences of people most reliant on the available public restroom facilities (survey)? The results of our case study demonstrate that these adaptable tools can be used to provide meaningful data on and a holistic picture of public restroom quantity, quality, accessibility, and the experiences of public restroom users in a given region.

Assessment of Safe Motherhood Health Service Coverage, Birth Defects Detection and Child Disability Prevention Using Lot Quality Assurance Sampling in Central Uganda.

It is crucial to have satisfactory coverage of safe motherhood services in order to prevent birth defects and child disabilities. Mildmay Uganda Institute of Health Sciences (MIHS) implemented a safe motherhood project aimed at preventing birth defects and child disabilities. Three years after the project's implementation, a rapid cross-sectional health facility survey was conducted in 4 districts of central Uganda to assess the coverage of key safe motherhood and early childhood services. The Lot Quality Assurance Sampling approach was used to assess coverage of 16 indicators in the areas of ANC, skilled birth attendance, early childhood care, postnatal care, and knowledge about child disability prevention. A Decision Rule was set at 80% upper threshold to classify the performance of health facilities at the district level. The survey found that there was variation in performance across indicators and districts. All districts achieved the 80% coverage target in ANC first visit, mothers who received at least two doses of Fansidar for intermittent preventive treatment of malaria in pregnancy, and mothers with knowledge of the action to take in case they suspect childhood disability. Folic acid supplementation during pregnancy and screening for birth defects using the Appearance, Pulse, Grimace, Activity, and Respiration (APGAR) score had overall coverage above the target, but one district each had coverage below target in each of these 2 indicators. The coverage target was not reached in the rest of the survey indicators in each of the districts. Well-performing districts, especially in indicators with inconsistent performance, offer valuable insights for learning and adapting interventions in districts that do not meet the desired coverage of those particular indicators. Considering the disparities in performance among different indicators and districts, project planners should adopt, modify and implement successful strategies in districts and indicators that perform well. By doing so, they can enhance the performance of under performing districts or indicators.

Readiness, access, and use of facility childbirth care in Ethiopia: results from nationally representative linked household and health facility surveys

Background Facility readiness is an important prerequisite for providing safe, effective childbirth care. This study assesses the readiness of health facilities in Ethiopia to provide childbirth services, describes variations in geographic access to service-ready facilities, and evaluates how facility readiness relates to childbirth service usage with a lens on equity. Methods The study used cross-sectional data from a nationally representative sample of households in Ethiopia linked with data from health facilities serving the same areas. We explored variation in childbirth service readiness across facilities and classified facilities as “service-ready” if they had a readiness score of 0.75 or higher on a 0-1 scale. We used logistic regression modeling to examine the odds of residing within 10 kilometers of a service-ready facility by socioeconomic and geographic characteristics, and the odds of a facility delivery given the readiness of nearby facilities. Results Childbirth service readiness was generally high for hospitals (median score: 0.92) with minimal variation (interquartile range, IQR: 0.88 to 0.96). Health centers and clinics displayed lower and more variable readiness (median: 0.75, IQR: 0.66 to 0.84). In both crude and adjusted regression analyses, odds of residing within 10 kilometers of a service-ready facility were significantly greater for women with higher education levels, greater wealth, and urban residence. We found the adjusted odds of using facility childbirth services were 1.23 (95% CI: 1.03, 1.48) times greater for each 0.10-unit increase in the readiness level of nearby facilities. Conclusions Access to childbirth care is not equal for Ethiopian women. Those living in rural areas and the poor must travel farther to reach facility childbirth services, and the nearest facilities serving these women were less prepared to provide quality care. This may contribute to lower service utilization by such disadvantaged groups of women.

Vaccine hesitancy among healthcare workers in low- and middle-income countries during the COVID-19 pandemic: Results from facility surveys across six countries.

Vaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs. We conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility. 1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population. Our findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging.

Spatial distribution of caesarean deliveries and their determinants in Bangladesh: evidence from linked data of population and health facility survey.

Health facility-level factors play a crucial role in women's access to and use of caesarean section (CS) services, but lacks relevant evidence. The study aimed to understand the effects of health facility-level factors on CS delivery in Bangladesh. The 2017-18 Bangladesh Demographic and Health Survey (2017-18 BDHS) and the 2017 Bangladesh Health Facility Survey (2017 BHFS) were linked and analysed in this study. The sample comprised of 4954 women gave at least one live birth within three years preceding the survey. The outcome variable was delivery through CS (yes, no) and the explanatory variables were health facility-level, individual-level, household-level, and community-level factors. Moran's I and Getis-Ord General G statistic were used to identify the hotspots of delivery through CS. Mixed-effect multilevel logistic regression was used to examine the association of the outcome variable with explanatory variables. Around 33% of women in Bangladesh underwent CS in their most recent pregnancies. The hotspots of delivery through CS are located primarily in Rajshahi, Dhaka, and Khulna divisions. The likelihood of delivered through CS increased with the rising scores of the management (Adjusted Odds Ratio (AOR), 1.83; 95% CI 1.04-2.07) and infrastructure (AOR, 3.14; 95% CI 1.40-5.12) of the nearest health facility. The readiness of health facilities to provide comprehensive obstetric care was significantly associated with an increased likelihood of delivery through CS (AOR, 2.18; 95% CI 1.15-3.28). These relationships were strong for private than non-government and government health facilities. The proximity of comprehensive obstetric care facilities to women's residences and their readiness to provide services play critical roles in the access to and use of CS in Bangladesh. The findings highlight the importance of necessary healthcare personnel, including midwives, availability of government hospitals where undue CS are avoided, and awareness-building programmes about the adverse effects of CS delivery. None.

Assessment of available health services at subcentres as per Indian public health standards guidelines in a district of Jammu and Kashmir India: A cross sectional study.

Subcentre is the lowest rung of a referral pyramid of health facilities. The purpose of health subcentre is mainly providing preventive and promotive services, but it also provides a basic level of curative services. To assess the existing services availability at subcentres and identification of gaps between minimum requirements as per Indian public health standards and actual availability of services at subcentres. It was a cross sectional observational study. Study units were subcentres. Fifty percent of subcentres of the district were selected using simple random sampling method. Check list prepared from Indian public health standards facility survey formats was used for data collection and collected data were analysed using statistical package for social sciences. Majority (58.8%) of the subcentres were catering a population in the range of 1000-3000. Ante-natal and child care related services were available in all subcentres. Intra-natal services were available in only two subcentres. Eighty five percent of subcentres were involved in providing school health related services. Most of the services as recommended by Indian public health standards were available in the studied subcentres. The lack of some services was mainly due to inadequate staff and infrastructure at subcentres. Comprehensive efforts are required to ensure adequate service delivery at all health centres.

Community and facility-level barriers to achieving UHC in Kono District, Sierra Leone and Maryland County, Liberia.

Universal Health Coverage (UHC) is achieved when individuals and communities receive the health services they need without suffering financial hardship. However, many countries face barriers to building health systems that enable the availability of affordable, accessible care. The goal of this study was to present a model of local monitoring of barriers and to provide a roadmap for designing interventions that improve access to and use of healthcare delivery systems. We conducted household, individual, and health facility surveys in seven catchment areas in Sierra Leone and Liberia between December 2019 and March 2020. A two-stage cluster sampling method was used to sample households and individuals, and all health facilities were included. We divide access barriers into demand (patient-side care seeking behavior), supply (availability of facilities and services), and their intersection (affordability, spending, and use rates). Among the 2,576 respondents within our 1,051 surveyed households, the propensity to seek care when ill was reported at 90% in Sierra Leone (n = 1,283) and 70% in Liberia (n = 806). We estimated that 31% of households spent greater than 10% of their total expenditure on healthcare in a month, and that 14.5% of households spent greater than 25%. Overall, the general service readiness index mean score for all health centers was around 70%. The greatest hindrance to service readiness was the availability of essential medicines, with facilities reporting an average score of 32% in Sierra Leone and 63% in Liberia. Our evidence suggests that the cost of care is both a barrier to care-seeking and a persisting problem among care-seeking patients. Lack of service availability (essential equipment and medicines), poses a risk to high-quality care. The research team recommends deploying interventions (visit cost subsidies, supply chain improvements) targeted at resolving these issues in order to advance the goal of achieving UHC.

The current status of emergency departments in secondary emergency medical institutions in Japan: a questionnaire survey

BackgroundWhile emergency medicine (ER)-based emergency care is prevalent in many countries, in Japan, the “department-specific emergency care model” and the “emergency center model” are mainstream. We hypothesized that many secondary emergency medical institutions in Japan have inadequate systems. Using a questionnaire, we investigated the status of and problems in the emergency medical services system in secondary emergency medical institutions in Japan. Until date, there has not been an exhaustive survey of emergency facilities on a countrywide scale. The main objective of this study was to investigate problems in the Japanese emergency medical services system and thereby improve optimal care for emergency patients.ResultsA nationwide questionnaire survey involving 4063 facilities (all government-approved emergency medical facilities certified by prefectural governors) in Japan was conducted. Of the facilities that responded, all secondary emergency facilities were included in the analysis. Responses from 1289 facilities without a tertiary emergency medical care center were analyzed. Among them, 61% (792/1289) had ≤ 199 beds, and 8% were emergency department specialty training program core facilities. Moreover, 42% had an annual patient acceptance number of ≤ 500, 19% did not calculate the number of acceptances, 29% had an acceptance rate of ≥ 81%, and 25% had an acceptance rate of 61–80%. Pregnant women (63%) and children (56%) were the major types of patients that affected the acceptance rate. Factors affecting facilities with a response rate of 81% or higher were “hospitals designated for residency training” and “facilities making some efforts to improve the quality of emergency care and the emergency medical system” (logistic analysis, P < .001).ConclusionRelevant authorities and core regional facilities should consider and implement specific measures for regions and hospitals with a shortage of emergency medicine specialists and physicians (e.g., development of ER-based emergency medicine and provision of education). This study may lead to further improvement in the optimal care of emergency patients through the nationwide establishment of the proposed measures as well as through grouping and integrating the structures and systems in emergency and other medical facilities.

Fermi Blazars in the Zwicky Transient Facility Survey: A Correlation Study

We report on our correlation analysis for the γ-ray blazars detected with the Large Area Telescope (LAT) onboard the Fermi Gamma-ray Space Telescope (Fermi), for which we use the Fermi-LAT data and the optical zr and zg band data from the Zwicky Transient Facility survey in the time period approximately from 2018 July to 2022 February. We start from the full sample of the Fermi-LAT blazars and find ∼38% of them as significant variables in both γ-ray and optical bands. Among the variables, which are 705 blazars, 95 are selected as our targets based on the requirement for the γ-ray brightnesses. Then 15 out of the 95 blazars are found to show the γ-ray–optical correlations in the ∼3.7 yr time period. Most of the 15 blazars are classified as low synchrotron peaked (LSP) ones with the time lags between the γ-ray and optical bands in a range from −19 to +25 days. The results generally fit the often-considered emission scenario for the LSP blazars. Two cases of showing ∼−100 days time lags are discussed, which require further studies for confirmation. Our analysis results suggest that among the detected significant variables, ∼23% LSPs can show γ-ray and optical correlations, while their average γ-ray fluxes are above ∼4 × 10−8 photon cm−2 s−1.

Protocol for the formative phase of a trial (SHE-CAN) to test co-designed implementation strategies for HPV-based cervical screening among vulnerable women in two diverse settings in India

BackgroundIn view of the WHO’s call for the elimination of cervical cancer as a public health problem, and current low screening coverage, Indian policy makers need evidence on how to effectively implement cervical screening programmes, ensuring equity in access.Our study will follow the INSPIRE implementation framework to co-design and test HPV-based screening approaches in two states of India with different health system organisation, based on understanding the status of screening as currently implemented, readiness and challenges to transition to HPV-based screening, and preferences of key stakeholders. Here, we describe our protocol for the formative phase of the study (SHE-CAN).MethodsThe study population includes women from vulnerable populations, defined as residents of tribal areas, rural villages, and urban slums, in the states of Mizoram and Tamil Nadu. The baseline assessment will use mixed methods research, with desktop reviews, qualitative studies, and surveys. A capacity assessment survey of screening and treatment facilities will be done, followed by interviews with healthcare providers, programme managers, and community health workers. Interviews will be conducted with previously screened women and focus group discussions with under and never-screened women and community members. Stakeholder workshops will be held in each state to co-design the approaches to delivering HPV-based screening among 30–49-year-old women.DiscussionThe quality and outcomes of existing screening services, readiness to transition to HPV-based screening, challenges in providing and participating in the cervical cancer care continuum, and acceptability of screening and treatment approaches will be examined. The knowledge gained about the current system, as well as recognition of actions to be taken, will inform a stakeholder workshop to co-design and evaluate implementation approaches for HPV-based screening through a cluster randomised implementation trial.

Reporting COVID-19 Cases through the Integrated Disease Surveillance and Response Network in the Southwestern State of Nigeria: A Health Facility Survey

Reporting COVID-19 Cases through the Integrated Disease Surveillance and Response Network in the Southwestern State of Nigeria: A Health Facility Survey

Factors Associated With the Quality of Life of Nursing Home Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Quality of life (QoL) of nursing home (NH) residents is critical, yet understudied, particularly during the COVID-19 pandemic. Our objective was to examine whether COVID-19 outbreaks, lack of access to geriatric professionals, and care aide burnout were associated with NH residents' QoL. Cross-sectional study (July to December 2021). We purposefully selected 9 NHs in Alberta, Canada, based on their COVID-19 exposure (no or minor/short outbreaks vs repeated or extensive outbreaks). We included data for 689 residents from 18 care units. We used the DEMQOL-CH to assess resident QoL through video-based care aide interviews. Independent variables included a COVID-19 outbreak in the NH in the past 2weeks (health authority records), care unit-levels of care aide burnout (9-item short-form Maslach Burnout Inventory), and resident access to geriatric professionals (validated facility survey). We ran mixed-effects regression models, adjusted for facility and care unit (validated surveys), and resident covariates (Resident Assessment Instrument-Minimum Data Set 2.0). Recent COVID-19 outbreaks (β= 0.189; 95% CI: 0.058-0.320), higher proportions of emotionally exhausted care aides on a care unit (β= 0.681; 95% CI: 0.246-1.115), and lack of access to geriatric professionals (β= 0.216; 95% CI: 0.003-0.428) were significantly associated with poorer resident QoL. Policies aimed at reducing infection outbreaks, better supporting staff, and increasing access to specialist providers may help to mitigate how COVID-19 has negatively affected NH resident QoL.

Service availability and readiness assessment of COVID-19 disease management at different tiers of health service delivery in Bangladesh

Background: The world is passing through a hard time due to the highly infectious COVID-19 pandemic. Like other countries in the world, the Bangladesh government has taken various preventive measures. As part of this, the availability and readiness of different health facilities is crucial. Objective: The study aimed to assess availability and readiness based on logistics, workforce, clinical management, and IPC. Methods: A cross-sectional quantitative study was conducted from August 20 to September 30, 2021, which comprised a health facility survey with a sample of 210. The health facilities included all three tiers of hospitals, covering 24 districts of eight divisions. All COVID-19 dedicated hospitals were included in this survey. The questionnaire consisted of a standard checklist developed by WHO, DGHS, and CDC. Results: The overall scores for ICU, HDU, and ventilation service were 76.8%, 87.5%, and 85.7%, respectively, but they were almost missing in Upazila health complex and below the average in non-dedicated hospitals. All (100%) secondary and tertiary level hospitals had a 24-hour staffed emergency unit, with dedicated hospitals outperforming non-dedicated hospitals (99.2% vs 98.7%). Above 90% of hospitals in different tiers had hand hygiene supplies and respiratory hygiene supplies for staff and patients, 98% of the primary level hospitals displayed instructions on hand and respiratory hygiene practices. On the other hand, 94.9% of secondary level hospitals had clearly identified and separated COVID-19 isolation areas from non-COVID-19 areas; 82.1% of secondary level hospitals had service providers (MOs) who used PPE; 97.4% had routine cleaning and disinfection of ambulances done according to IPC guidelines; and 64.1% had staff of laboratory, laundry, food services, and waste management teams who used appropriate PPE. Secondary level hospitals had a better availability of PPE compared to primary and tertiary level hospitals, which consisted of protective gowns (87.8%), disposable latex gloves (examination) (92.5%), goggles, protective (82.9%), face shields (72.5%), respirator masks (N95 or FFP2) (75.0%), and masks, medical/surgical (97.6%) available for all health service providers. Almost 26.2% facility have PCR testing lab and almost all (96.7%) the facilities have specimen collection system in their facility. Conclusion: The service availability and readiness regarding COVID-19 among different tiers of health facilities in Bangladesh are not adequate. We need more support for disease detection capacities through provision of technical expertise, laboratory equipment and increase capacity of the secondary and primary health care tier along with national capacity for covid-19 testing. Bangladesh Medical Res Counc Bull 2022; 48: 160-171

Caring for patients with periprosthetic femoral fractures across England and Wales in 2021.

The aim of this study was to describe services available to patients with periprosthetic femoral fracture (PPFF) in England and Wales, with focus on variation between centres and areas for care improvement. This work used data freely available from the National Hip Fracture Database (NHFD) facilities survey in 2021, which asked 21 questions about the care of patients with PPFFs, and nine relating to clinical decision-making around a hypothetical case. Of 174 centres contributing data to the NHFD, 161 provided full responses and 139 submitted data on PPFF. Lack of resources was cited as the main reason for not submitting data. Surgeon (44.6%) and theatre (29.7%) availability were reported as the primary reasons for surgical delay beyond 36 hours. Less than half had a formal process for a specialist surgeon to operate on PPFF at least every other day. The median number of specialist surgeons at each centre was four (interquartile range (IQR) 3 to 6) for PPFF around both hips and knees. Around one-third of centres reported having one dedicated theatre list per week. The routine discussion of patients with PPFF at local and regional multidisciplinary team meetings was lower than that for all-cause revision arthroplasties. Six centres reported transferring all patients with PPFF around a hip joint to another centre for surgery, and this was an occasional practice for a further 34. The management of the hypothetical clinical scenario was varied, with 75 centres proposing ORIF, 35 suggested revision surgery and 48 proposed a combination of both revision and fixation. There is considerable variation in both the organization of PPFF services England and Wales, and in the approach taken to an individual case. The rising incidence of PPFF and complexity of these patients highlight the need for pathway development. The adoption of networks may reduce variability and improve outcomes for patients with PPFF.

Ready or not: Emergency preparedness in residential care facilities for the elderly (RCFE) in California.

This study examined the results of an electronic survey of residential care facilities for the elderly (RCFE) in California in 2021 to provide insight on key elements of emergency plans and facility preparedness for the COVID-19 pandemic and future emergencies. Surveys were distributed to RCFE administrators using publicly available emails found on the California Health and Human Services Open Data Portal. Responses from 150 facility administrators included data on their perception of current and future facility preparedness for COVID-19 and other emergency scenarios, items included in facility evacuation/shelter-in-place plans, and hazard vulnerability analyses and training practices of facility staff. Descriptive analyses were performed on collected data. The majority of results were from small facilities serving less than seven residents (70.7 percent). Prior to COVID-19, more than 90 percent of respondents included disaster drills, evacuation plans, and emergency transportation in their emergency preparedness plan. The majority of facilities added pandemic planning, vaccine distribution, and quarantine guidelines elements into their plans during COVID-19. Approximately half of facilities reported conducting proactive hazard vulnerability analyses. Around 75 percent of RCFEs felt well prepared for fires and infectious disease outbreaks, had mixed preparedness levels for earthquakes and floods, and felt least prepared for landslides and active shooter emergencies. During the pandemic, perceptions of preparedness rose, with 92 percent stating they felt very prepared currently and almost 70 percent felt very prepared for future pandemics. Preparedness of these essential facilities and their residents can continue to improve by conducting regular proactive hazard vulnerability analyses, improving communication lines and mutual aid agreements with local and state organizations, and preparing for critical emergencies such as landslides and active shooter scenarios. This can help to ensure adequate resources and investments are provided to care for older adults during emergencies.